Relationship between Admission Temperature and Risk of Cerebral Palsy in Infants Admitted to Special Care Unit in a Low Resource Setting: A Retrospective Single-Center Study.

Chiara Guadagno,Gaetano Azzimonti,Donald Micah Maziku,Daniele Trevisanuto,Luca Brasili,Francesco Cavallin,Andrea Pietravalle,Giovanni Putoto,Dionis Erasto Leluko

doi:10.3390/children9030352

Abstract

Background: Deviations from normothermia affect early mortality and morbidity, but the impact on neurodevelopment of the survivors is unclear. We aimed to investigate the relationship between neonatal temperature at admission and the risk of cerebral palsy (CP) at one month of age in a low-resource setting. Methods: This retrospective study included all inborn neonates admitted to the Special Care Unit of Tosamaganga Hospital (Tanzania) between 1 January 2019 and 31 December 2020. The neurological examination at one month of age was performed using the Hammersmith method. The relationship between the admission temperature and the risk of CP was investigated using logistic regression models, with temperature modeled as the non-linear term. Results: High/moderate risk of CP was found in 40/119 (33.6%) of the neonates at one month of age. A non-linear relationship between the admission temperature and moderate/high risk of CP at one month of age was found. The lowest probability of moderate/high risk of CP was estimated at admission temperatures of between 35 and 36 °C, with increasing probability when departing from such temperatures. Conclusions: In a low-resource setting, we found a U-shaped relationship between the admission temperature and the risk of CP at one month of life. Expanding the analysis of the follow-up data to 12–24 months of age would be desirable in order to confirm and strengthen such findings.

Highlights

About 2.4 million neonates still die every year globally, with a greater risk in their first day of life [1]
This study aimed to investigate the relationship between neonatal temperature at admission and risk of Cerebral palsy (CP) at one month of age in a low-resource setting
Our findings showed a small proportion of neonatal normothermia in a low-resource setting and a non-linear relationship between the admission temperature and the risk of CP at one month of life

Summary

Introduction

About 2.4 million neonates still die every year globally, with a greater risk in their first day of life [1]. As neonatal temperature early after birth seems to play a crucial role, the World Health Organization (WHO) guidelines focused on thermal control since. 1993, in order to support health care providers in thermal management and prevention of thermal loss [2]. Deviations from normothermia have been demonstrated to be important contributors to neonatal morbidity and mortality in both high- and low-resource settings [3,4]. Thermal control at birth is a critical challenge in low-resource settings, where proper thermal care is often inadequate and thermal stability is underestimated in management protocols [5–8]. Despite WHO recommendations, deviations from normothermia remain a public health issue in low-resource settings, where it is often under-recognized, under-documented, and poorly managed [8,9]. Beyond early mortality and morbidity, it is reasonable to suspect that deviations from normothermia may impact the neurodevelopment of survivors [10].

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